Kenneth Raske, top dog at the Greater New York Hospital Association, has a million reasons to derail Gov. Spitzer’s efforts to control health-care costs in New York state.

More precisely, he has 1,137,141 reasons.

Raske’s 2004 salary in 2004 totaled $943,554, according to documents filed with the Internal Revenue Service.

The hospital association contributed an additional $193,587 in benefits to Raske’s compensation package that year – and no doubt he’s done as well, if not much better, in the intervening years.

So, never mind Top Dog.

How about Fat Cat?

Spitzer last Friday took on Raske and his partner in health-care overspending, union boss Dennis Rivera, during a breakfast address to business leaders at a Midtown hotel.

Raske and Rivera are the folks behind a multi-million-dollar ad campaign airing all across New York and aimed squarely at Spitzer’s effort to reduce the rate of growth in publicly financed hospital subsidies and related spending.

The ads also are meant to stiffen the spines of the R&R Boys’ Albany hirelings – Senate Majority Leader Joe Bruno and Assembly Speaker Sheldon Silver.

At issue is whether Spitzer can keep his promise to “change Albany.”

Spitzer knows that the state spends way too much money on health care relative to what it gets in return. He wants to put patients first – as opposed to, say, Raske’s salary.

But such changes run up against the goals of Rivera and Raske – who were installed in their positions not by patients, but by health-care industry bosses.

Their stunningly disingenuous ad campaign – they’re spending a reported $15 million – is meant not only to protect Raske’s paycheck, but also hospital-administration salaries that can top $5 million annually.

And, of course, the decidedly more modest salaries of Rivera’s union members; they’re not getting rich, to be sure, but there are far more of them than is necessary to protect the health of New Yorkers – and because of their numbers Rivera grows ever more powerful.

Bottom line?

It’s all about money.

And Silver and Bruno hold the purse strings. They’re the ones the industry is really targeting.

Historically, Raske and Rivera have held the legislative leadership in thrall.

They dole out millions in campaign contributions, lobbying fees and advertising buys to protect the status quo – their own positions, to be sure, but also Silver’s and Bruno’s jobs.

And the taxpayers get the bill.

So Gov. Steamroller’s going to need all the steam he can muster. And he’s got another weapon: the truth.

Health care in New York is out of control – and New Yorkers know it.

The state underwrites more Medicaid spending-both in absolute dollars and per capita – than any other state. It far and away leads the nation in per-capita hospital spending.

Spitzer cites subsidies for empty hospital and nursing-home beds and what he calls “phantom” resident doctors. He says reimbursement rates are outdated, and the state pays far too much for medicine – all relative to other states.

And even Spitzer admits that he seeks no cuts in Medicaid benefits – just a slowing of growth. And he actually wants to expand coverage.

That’s not good enough for Raske, who was made a millionaire by the sytem.

Or Rivera, who now plays on a national stage because of it.

Together, they represent Spitzer’s toughest test to date – and perhaps of his entire incumbency.